11-28-2007, 05:52 PM
the given anw is b
|
q3 - strongman
|
11-28-2007, 06:03 PM
first of all ...to see if the kidney is normal, do BUN/creatinine=110/6=18.3, so more than 15(patho goljan) means that the kinney do filtration of BUN...the kidney concentrate the urine, they are normal..
this pat has a sign of KIMMELSTIEL WILSON disease(diabetic glomerulosclerosis) which is a nephrotic syndrome..that's why all signs af edema, crackles... i hope it is worth my explanation..
11-28-2007, 06:06 PM
strongman..can you release the explanation?
thank mira
11-28-2007, 06:22 PM
mira this patient has diabetic nephropathy!!!
and yes as you said he has nephrotic syndrome and this is causing the kidnye to start failing.... this patient have uremic symptoms!!!!(very classic)plus the signs of the nephrotic syndrome so: Renal replacement therapies As for any other patient with ESRD, diabetic patients with ESRD can be offered hemodialysis, peritoneal dialysis, kidney transplantation, or combined kidney-pancreas transplantation. In patients with uremia of any cause, starting at a creatinine clearance of 10-15 mL/min is wise. In diabetic patients, starting earlier is useful when hypervolemia renders blood pressure uncontrollable, when the patient experiences anorexia and cachexia or other uremic symptoms, and when severe vomiting is the combined result of uremia and gastroparesis
11-28-2007, 06:44 PM
open and shut case of uremia needing dialysis due to the pulmonary edema and a creatinine of 6 in a DM ptt which are independent indications of dialysis...
the ptt also has anemia of CRF..may be met acidosis seeing his pco2 which might be due to compensatory resp alkalosis..generalized wasting....hyperphosphatemia.borderline high potassium its just not DKA....how did guys get his AG as no HCO3 value is given..there is no abdominal pain, no dehydration, RR is normal, no fever or trigger, good sugar levels at home, no fruity odor to her breath etc..... |
| « Next Oldest | Next Newest » |